Knowledge of asthma and anaphylaxis among teachers in Spanish schools

Introduction: Allergic diseases affect 15-20% of the paediatric population in the industrialised world. Most educational centres in Spain do not have health professionals among their staff, and the teachers are in charge of child care in school. The advisability of specific training of the teaching staff should be considered, with the introduction of concrete intervention plans in the event of life-threatening emergencies in schools. Material and methods: Evaluation of the training needs constitutes the first step in planning an educational project. In this regard, the Health Education Group of the Spanish Society of Clinical Immunology, Allergology and Paediatric Asthma (Grupo de Educación Sanitaria de la Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica [SEICAAP]) assessed the knowledge of teachers in five Spanish Autonomous Communities, using a self-administered questionnaire specifically developed for this study. The data obtained were analysed using the SPSS statistical package. Results: A total of 2479 teachers completed the questionnaire. Most of them claimed to know what asthma is, and almost one half considered that they would know how to act in the event of an asthma attack. This proportion was higher among physical education teachers. Most would not know how to act in the case of anaphylaxis or be able to administer the required medication. In general, the teachers expressed interest in receiving training and in having an interventional protocol applicable to situations of this kind. Discussion: It is important to know what the training requirements are in order to develop plans for intervention in the event of an emergency in school. Teachers admit a lack of knowledge on how to deal with these disorders, but express a wish to receive training (AU)

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Knowledge of asthma and anaphylaxis among teachers in Spanish schools.

INTRODUCTION: Allergic diseases affect 15-20% of the paediatric population in the industrialised world. Most educational centres in Spain do not have health professionals among their staff, and the teachers are in charge of child care in school. The advisability of specific training of the teaching staff should be considered, with the introduction of concrete intervention plans in the event of life-threatening emergencies in schools. MATERIAL AND METHODS: Evaluation of the training needs constitutes the first step in planning an educational project. In this regard, the Health Education Group of the Spanish Society of Clinical Immunology, Allergology and Paediatric Asthma (Grupo de Educación Sanitaria de la Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica [SEICAAP]) assessed the knowledge of teachers in five Spanish Autonomous Communities, using a self-administered questionnaire specifically developed for this study. The data obtained were analysed using the SPSS statistical package. RESULTS: A total of 2479 teachers completed the questionnaire. Most of them claimed to know what asthma is, and almost one half considered that they would know how to act in the event of an asthma attack. This proportion was higher among physical education teachers. Most would not know how to act in the case of anaphylaxis or be able to administer the required medication. In general, the teachers expressed interest in receiving training and in having an interventional protocol applicable to situations of this kind. DISCUSSION: It is important to know what the training requirements are in order to develop plans for intervention in the event of an emergency in school. Teachers admit a lack of knowledge on how to deal with these disorders, but express a wish to receive training.

[Role of aeroallergens in the etiopathogenesis of atopic dermatitis]. / Importancia de los aeroalergenos en la etiopatogenia de la dermatitis atópica.

UNLABELLED: Atopic dermatitis is a chronic relapsing inflammatory skin disease. It is most frequent in childhood and its clinical manifestations vary with age. The etiopathogenic mechanisms that explain this process are still poorly understood; several studies performed in adults speculate on the possible role of aeroallergens through direct contact with the skin but, because the etiology of this disease varies with age, studies in children of different ages are required. AIMS: (i) To determine whether children with atopic dermatitis are sensitized to inhalant allergens. (ii) To determine whether these inhalant allergens cause dermatitis or whether they provoke allergic respiratory disease (asthma, rhinitis) concomitant with atopic dermatitis. (iii) To evaluate whether sensitization to a particular allergen takes place at any age or whether there are differences according to age. MATERIAL AND METHODS: This study was performed in the following groups: (i) 64 children with atopic dermatitis, divided into two subgroups, one consisting of 37 children who also presented allergic respiratory disease (asthma, rhinitis) (AR) and another subgroup of 27 patients who presented atopic dermatitis only. (ii) CONTROL GROUP: eight children who presented AR only, to determine whether this group reacted to patch testing with inhalant allergens. (iii) CONTROL GROUP: seven healthy children to rule out non-specific positive tests in the non-atopic population. All groups were divided by age according to the phases of atopic dermatitis: early childhood phase (< 2 years): 21, childhood phase (2-10 years): 37, adolescent phase (> 10 years): 21. In all children total serum IgE determination (RIA), allergen-specific IgE determination (RAST), prick- and patch test were performed. In the three tests the same allergens were used, consisting of the usual components of standardized inhalant and food allergens. When the results of patch testing were positive, biopsy and histopathological analysis were performed and monoclonal antibodies were used to determine reproducibility of the eczematous lesion. RESULTS: Sensitization was found to differ among patients with atopic dermatitis according to whether they presented respiratory symptoms and according to age with a clear predominance of food sensitization in the group aged less than 2 years. In the group aged 2-10 years, mixed sensitization predominated, mainly because of simultaneous respiratory involvement, but it is highly probably that inhalant allergens participate in the etiopathogenesis of atopic dermatitis. In children aged more than 10 years sensitization to inhalant allergens predominated as most presented respiratory symptoms. Patch testing was positive in 34.3 % of patients with atopic dermatitis and approximately half were positive to dust mites. The patch test is of great diagnostic value in atopic dermatitis and none of the tests were positive in the control group. All the biopsies of patch tests with inhalant allergens reproduced the lesions typical of eczema, demonstrating their involvement in the etiopathogenesis of dermatitis.

Importancia de los aeroalergenos en la etiopatogenia de la dermatitis atópica / Role of aeroallergens in the etiopathogenesis of atopic dermatitis

La dermatitis atópica (DA) es una enfermedad inflamatoria cutánea crónica y recidivante, es más frecuente en la infancia y su aspecto clínico difiere según la edad. Los mecanismos etiopatogénicos que permiten explicar este proceso todavía son poco conocidos, diversos trabajos en adultos especulan sobre el papel que pueden jugar los aeroalergenos por contacto directo sobre la piel, faltando trabajos en niños de diferentes edades, puesto que la etiología puede ser variable en función de la edad. Objetivos: 1) Comprobar si los niños afectados de DA están sensibilizados a neumoalergenos. 2) Comprobar si esos neumoalergenos son responsables de la dermatitis o si son la causa de alguna enfermedad respiratoria de etiología alérgica (asma, rinitis) concomitante con la DA. 3) Verificar si la sensibilización a uno u otro tipo de alergeno tiene lugar a cualquier edad o si se observan diferencias en distintas edades. El estudio se ha efectuado en los siguientes grupos: 1) 64 niños afectos de DA: se han separado en 2 subgrupos, uno de 37 niños que además padecían algún proceso alérgico respiratorio (asma y/o rinitis) (AR), y otro subgrupo de 27 pacientes que sólo tenían DA. 2) Grupo control: 8 niños que sólo padecían AR, para comprobar si este grupo reacciona a la prueba del parche con neumoalergenos. 3) Grupo control: 7 niños sanos para descartar pruebas positivas inespecíficas en la población no atópica. Todos los grupos se han dividido por edades de acuerdo con las fases de la DA: fase lactante (< 2 años): 21, fase infantil (2-10 años); 37, fase adolescente (> 10 años): 21. A todos se les efectuó: IgE sérica total (RIA), IgE alergeno específica (RAST), prick-test y patch-test. En las tres pruebas se utilizaron los mismos alergenos, componentes habituales del estándar de neumoalergenos y alergenos alimentarios. En caso de prueba del parche positiva se realizó biopsia con estudio anatomopatológico y con Ac. monoclonales para ver si se reproduce la lesión de eczema. Se comprobó que existía diferente sensibilización entre los pacientes con DA según presenten clínica respiratoria y según la edad, con un claro predominio de sensibilización a alimentos en el grupo de menos de 2 años. En la edad intermedia de 2 a 10 años destaca la sensibilización mixta, en gran parte por la afectación respiratoria simultánea, pero es muy probable que los neumoalergenos participen en la etiopatogenia de la DA. En los mayores de 10 años predomina la sensibilización a neumoalergenos por coincidir la mayoría con clínica respiratoria. Un 34,3 % de pacientes con DA presentan prueba del parche positiva, siendo prácticamente la mitad positivas a ácaros. La prueba del parche proporciona un importante valor diagnóstico en la DA, no encontrándose ninguna prueba positiva en el grupo control. Todas las biopsias de pruebas del parche a neumoalergenos reproducen la lesión típica del eczema lo que demuestra su implicación en la etiopatogenia de la dermatitis (AU)

Atopic dermatitis is a chronic relapsing inflammatory skin disease. It is most frequent in childhood and its clinical manifestations vary with age. The etiopathogenic mechanisms that explain this process are still poorly understood; several studies performed in adults speculate on the possible role of aeroallergens through direct contact with the skin but, because the etiology of this disease varies with age, studies in children of different ages are required. Aims: (i) To determine whether children with atopic dermatitis are sensitized to inhalant allergens. (ii) To determine whether these inhalant allergens cause dermatitis or whether they provoke allergic respiratory disease (asthma, rhinitis) concomitant with atopic dermatitis. (iii) To evaluate whether sensitization to a particular allergen takes place at any age or whether there are differences according to age. Material and methods: This study was performed in the following groups: (i) 64 children with atopic dermatitis, divided into two subgroups, one consisting of 37 children who also presented allergic respiratory disease (asthma, rhinitis) (AR) and another subgroup of 27 patients who presented atopic dermatitis only. (ii) Control group: eight children who presented AR only, to determine whether this group reacted to patch testing with inhalant allergens. (iii) Control group: seven healthy children to rule out non-specific positive tests in the non-atopic population. All groups were divided by age according to the phases of atopic dermatitis: early childhood phase (< 2 years): 21, childhood phase (2-10 years): 37, adolescent phase (> 10 years): 21. In all children total serum IgE determination (RIA), allergen-specific IgE determination (RAST), prick- and patch test were performed. In the three tests the same allergens were used, consisting of the usual components of standardized inhalant and food allergens. When the results of patch testing were positive, biopsy and histopathological analysis were performed and monoclonal antibodies were used to determine reproducibility of the eczematous lesion. Results: Sensitization was found to differ among patients with atopic dermatitis according to whether they presented respiratory symptoms and according to age with a clear predominance of food sensitization in the group aged less than 2 years. In the group aged 2-10 years, mixed sensitization predominated, mainly because of simultaneous respiratory involvement, but it is highly probably that inhalant allergens participate in the etiopathogenesis of atopic dermatitis. In children aged more than 10 years sensitization to inhalant allergens predominated as most presented respiratory symptoms. Patch testing was positive in 34.3 % of patients with atopic dermatitis and approximately half were positive to dust mites. The patch test is of great diagnostic value in atopic dermatitis and none of the tests were positive in the control group. All the biopsies of patch te (AU)